Medication-assisted treatment: An update

Michael Boyle, Senior Innovation Officer
Center for Health Enhancement Systems Studies/NIATx

NIATX published Getting Started with Medication-assisted Treatment: Lessons from Advancing Recovery in 2010 to help organizations adopt and implement medication-assisted treatment (MAT). The toolkit offers several case studies on how treatment organizations in several states addressed the most common barriers to implementing MAT, including overcoming staff and community resistance, paying for MAT, and in the case of treatment for opioid dependence, finding prescribers. What is the current status of adoption of MAT within US treatment organizations, and do those barriers persist? 

Perhaps the best source of that information comes from several studies done by Dr. Paul Roman, Director of the Center for Research on Behavioral Health and Human Service Delivery at the University of Georgia. Dr. Roman and his associates have conducted telephone interviews with administrators and clinicians in a nationally representative sample of addiction treatment organizations to identify treatment practices utilized, including MAT.

The following data is from two studies conducted between 2009–2012 and 2011–2013.

• A study of 307 programs examined the use of acamprosate (Campral) for alcohol use disorders. While 18% of the organization reported adoption of use of the medication, only 6% of patients treated for alcohol received a prescription for the medication.
• The same survey examined the use of injectable naltrexone (Vivitrol). Thirteen percent of the providers reported using it for alcohol treatment and 3% used the medication for opiate treatment. Yet, only 4.1% of patients treated for alcohol and 7.1% treated for opiates received the medication.
• In another study of 372 organizations, 23.6% identified that they had adopted at least one MAT for the treatment of an alcohol use disorder. Providers who offered primary medical care or addressed co-occurring psychiatric disorders were more likely to be adopters of MAT. (See SAMHSA’s new guidance on MAT for alcohol use disorders.)
• Use of MAT with adolescents was also studied. Seventeen percent of organizations treating teens reported use of acamprosate.  The use of disulfiram (Antabuse), naltrexone, and or buprenorphine ranged from 9-11% among the programs surveyed.
• Two studies looked at changes in the use of medications for opiate treatment between 2007 and 2010. Overall, there was no change in MAT use, with 34% providing medications in 2007 and 32% in 2010. Of patients treated for an opiate use disorder, 13% were provided medication in 2007 and 14% received MAT in 2010. Higher percentages of Medicaid and private insurance billing and staff medication expertise were associated with greater MAT use.

The knowledge and attitudes of counselors regarding the use of medication-assisted treatment was also studied. Questionnaires were sent to the counselors at the 307 treatment programs. The results demonstrated that 20.7% of the counselors lacked the knowledge to rate the effectiveness of methadone or buprenorphine for the treatment of opiate dependency. Further, more than 50% were unable to rate the effectiveness of disulfiram, acamprosate, naltrexone or injectable naltrexone for the treatment of an alcohol use disorder.  Orientation to a 12-step approach was negatively associated with acceptability of MAT.

Everett Rogers extensively studied the process of adoption of new innovations. In Diffusion of Innovations, Rogers noted that a critical mass of adopters is needed before a new process or product is widely adopted. In most studies, an innovation spreads rapidly once an adoption level of approximately 20% is reached. Overall, the data from the studies cited here indicate that the substance use treatment field has not yet reached a critical mass for adopting medication-assisted treatment.

Dr. Roman’s studies suggest that treatment programs and their clinical staff members need more training and exposure to MAT. Getting Started with Medication-assisted Treatment, available as a free, downloadable PDF on the NIATx website, is a valuable resource for providing this exposure. 

A few other useful resources on medication-assisted treatment

The Bridge, Vol. 4:3. Buprenorphine and Integration

Your Doctor Understands Your Addiction: ATTC Network web-based resource

Buprenorphine Treatment: NIDA/SAMHSA-ATTC Blending Initiative

Studies citied in this report:

Aletraris, L, Bond Edmond M., Roman, P.M. (2015). Adoption of injectable naltrexone in U.S. substance use disorder treatment programs. Journal of Studies on Alcohol and Drugs, 76 (1);143-51.

Knudsen, H., Roman, P.M. (2014). Dissemination, Adoption, and Implementation of Acamprosate for Treating Alcohol Use Disorders.  Journal of Studies on Alcohol and Drugs, 75 (3): 467-75.

Roman, P.M., et al. (2015) Service delivery and pharmacotherapy for alcohol use disorder in the era of health reform: Data from a national sample of treatment organizations.  Accepted for publication in Substance Abuse.

Aletraris, L. Paino, M., and Roman, P.M. (2015). Organizational predictors of evidence-based practices in adolescent substance abuse treatment. Accepted for publication in Substance Abuse.